Cost Of Services Research Articles

Assessing the long-term care (LTC) service needs of older adults based on time-driven activity-based costing (TDABC)–a cross-sectional survey in central China

BackgroundThe global population’s aging has led to an increasing demand for long-term care (LTC), especially in developing countries like China. Comprehensive assessment of LTC service demands by including the time and cost analysis is crucial to inform the planning and financing of LTC resources, yet such research is lacking in China. Our research team has developed a quantitative index system of the medical and nursing services needs of older adults (QISMNSNE) based on the framework of Time-Driven Activity-Based Costing (TDABC), providing a valuable tool for measuring LTC service needs. This study aimed to assess the LTC service needs of older adults in China and the factors associated with such needs.MethodsA cross-sectional study was conducted in Changsha City, Hunan Province, China, from June 2021 to December 2022. A stratified multistage cluster sampling method was used to recruit 1,270 older adults from five nursing homes and three communities/streets in three regions of Changsha City. The LTC service needs were assessed by calculating the service time required from caregivers, nurses, and doctors and the total service time (min/d) using the QISMNSNE. Participants’ disability, activities of daily living (ADLs), mental status and social involvement (MSSI), and sensory and communication (SC) were assessed using standard scales. Generalized linear regression models were used to analyze factors associated with LTC service needs.ResultsThe participants had an average age of 76.41 ± 8.38 years, with 43.7% being female. The median service time required from caregivers, nurses, and doctors was 53.34 min/d, 3.66 min/d, and 0.33 min/d, respectively, and the total service time was 83.31 min/d. The generalized linear regression model identified the following factors that were associated with higher total service time: aged 75–84 years, living in nursing homes, income over 5000 per month, ADLs, MSSI (9 ~ 40), SC, and having 3 ~ 4 kinds of geriatric comorbidity (P < 0.05).ConclusionsOlder adults have a high need for LTC services, especially those provided by caregivers, indicating an urgent need to expand and improve LTC systems. The LTC service time needed is associated with multilevel factors encompassing socio-demographic, functional, and psychological aspects. This study offers preliminary insights into the needs, demands, and costs of LTC services for older adults and provides essential guidance for future planning and financing of LTC resources.

Association of advance care planning with hospital use and costs at the end of life: a population-based retrospective cohort study

ObjectiveTo investigate associations between the availability and timing of digitally available advance care planning (ACP) documents and hospital use and costs during the last 6 months of life.DesignRetrospective population-based cohort...

Estimated frequency and economic burden of incident fragility fractures during 2023 in Mexico.

Osteoporosis and its fractures impose a high clinical and economic burden. The objective of this analysis was to estimate the frequency and costs owing to incident fragility fractures (FFs) during the year 2023 in Mexico. This is an incidence-based cost-of-illness study. The target population is adults ≥ 50years old sustaining a fracture related to osteoporosis (caused by a fall on the same level). The model estimates the costs and productivity losses associated with their treatment within 1year post-fracture. National epidemiologic databases supplemented with information, derived from literature when appropriate, were used to estimate the frequency of new FFs during 2023 in the study population. Resource use included surgical and non-surgical inpatient or ambulatory care the patients received immediately after fracture plus the outpatient physiotherapy post-discharge and the eventual follow-up with a specialist who may prescribe pharmacotherapy. Sick days taken in employed patients were estimated from the literature. Local unitary costs of services and drugs for both public and private settings as well as average income in those occupied were applied. All costs are reported in Mexican pesos (MXN) from 2023. The model estimated a total of 229,239 FFs, among which 63% were classified as a major osteoporotic fracture, including 53,842 and 41,459 fractures located at the hip and vertebral, respectively. The total costs were estimated at 15,593 million MXN; most of them (75.2%) were attributable to acute-phase care. Fragility fractures represent a serious health problem for Mexico. Better preventive/therapeutic strategies may help to mitigate their significant financial toll.

Auctioning Long-Term Projects under Financial Constraints

Abstract We consider a procurement auction for the provision of a basic service to which an add-on must later be appended. Potential providers are symmetric, have private information on their cost for the basic service and the winning firm must also implement the add-on. To finance value-enhancing activities related to the add-on, this firm may need extra funding by outside financiers. Non-verifiable effort related to these activities creates a moral hazard problem which makes the firm’s payoff function for the second period concave in returns over the relevant range. Concavity has two effects. First, it makes it more attractive to backload payments to facilitate information revelation. Second, uncertainty on the cost of the add-on introduces a background risk which requires a risk premium. In this context, we characterize the optimal intertemporal structure of payments to the winning firm, equilibrium bidding behavior and reserve prices for a first-price auction.

Economic analysis of implementing Systemic Coronary Risk Estimation (SCORE2) scale and long-term consequences

Objective: to assess the demand for pharmacotherapy in risk groups on adverse cardiovascular (CV) events identified during prophylactic medical examination of the adult population according to the SCORE2 (Systemic Coronary Risk Estimation) scale, which is being introduced into clinical practice.Material and methods. To analyze the economic consequences of including diagnostic examinations to assess the risk by SCORE and SCORE2 scales, a Markov model was developed, which described the course of lipid metabolism disorders in adult patients aged 40 to 69 years without concomitant diseases identified during prophylactic medical examination. The model cycle was 2 months (the average waiting time for response to therapy); the modeling horizon was 3 years; the calculated values were estimated for the period 2024–2026. The economic analysis of long-term consequences involved calculating the cost of pharmacotherapy and the costs associated with CV events at outpatient and inpatient stages of medical care. The costs of drug therapy were determined based on dosage regimens presented in instructions for medical use in Russia, and clinical guidelines.Results. According to the modeling results, in the period 2024–2026, the administration of pharmacotherapy to reduce the risks of CV events will enable to achieve 23,224 potentially saved lives through exclusively government funding or 23,605 through mixed sources of funding (government and citizens’ own funds). The cost of the analyzed pharmacotherapy upon the introduction of the SCORE2 scale will be from 50.18 billion rubles (with government funding) to 318.14 billion rubles. Concurrently, pharmacocorrection will provide a reduction in the costs of inpatient treatment and outpatient medical services to 4.1 billion rubles due to the achieving of intended low-density lipoprotein level, and 1.6 billion rubles due to the achieving of intended triglyceride levels.Conclusion. Using new SCORE2 scale may lead to changes in the practice of prescribing lipid-lowering prophylaxis of CV diseases, as well as to a sharp increase in the number of patients who may require earlier prescription of pharmacotherapy to prevent CV events.

A Dynamic Edge Server Placement Scheme Using the Improved Snake Optimization Algorithm

In the paradigm of mobile edge computing (MEC), providing low-latency and high-reliability services for users is garnering increasing attention. Appropriate edge-server placement is the crucial first step to realizing such services, as it can meet computation requirements and enhance resource utilization. This study delves into efficient and intelligent dynamic edge-server placement by taking into account time-varying network scenarios and deployment costs. Firstly, edge servers are classified into static and dynamic ones. Subsequently, an improved snake optimization algorithm is proposed to determine the number and placement locations of dynamic servers while adhering to delay requirements. Finally, a minimum placement-cost algorithm is put forward to further reduce the service cost. Experimental results demonstrate that compared to classic algorithms, the proposed algorithms can achieve a reduction in latency of 5% to 12%. And compared to the state-of-the-art methods, they can reduce service costs by 20% to 43%. This research offers an effective solution for dynamic edge-server placement and holds great theoretical and practical significance.

Costs of physician and diagnostic imaging services for shoulder, knee, and low back pain conditions: A population-based study in Alberta, Canada

Objectives To 1) estimate the utilization and costs of physician and diagnostic imaging (DI) services for shoulder, knee, and low-back pain (LBP) conditions; and 2) examine determinants of the utilization and costs of these services. Methods All patients visiting a physician for shoulder, knee, or LBP conditions (identified by the ICD-9 codes) in Alberta, Canada, in fiscal year (FY) 2022/2023 were included. Interested outcomes included numbers and costs of physician visits and DI exams stratified by condition, physician specialty, DI modality, and patients’ sex and age. Multivariate regressions were used to examine determinants of the outcomes. Results In FY 2022/2023, 10.4%, 7.0%, and 6.7% of the population saw physicians for shoulder, knee, and LBP conditions, respectively. This costs Alberta $307.04 million ($67.93 per capita), of which shoulder accounted for 41%, knee 28%, and LBP 31%. In the same FY, 17,734 computed tomography (CT), 43,939 magnetic resonance imaging (MRI), 686 ultrasound (US), and 170,936 X-ray exams related to shoulder/knee/LBP conditions were ordered for these patients, costing another $29.07 million, of which CT accounted for 14%, MRI 48%, US 0%, and X-ray 37%. Female, older age, comorbidity scores, and capital zone used physician services more frequently. Patients with a higher comorbidity index scores or more physician visits were more likely being referred for CT or MRI. Conclusion Musculoskeletal conditions are common and result in patients seeking healthcare services. Visits to family physicians, specialists, and the ordering of DI contribute to extensive utilization of health services, contributing to considerable health system costs.

Implication of Macroeconomic Fundamentals on the Twin-Evil of Macroeconomic Phenomena: “With the Focus on Nigeria”

Purpose of the Study: This study was designed to analyze the implication of Macroeconomic fundamentals on twin-evil of Macroeconomic phenomena: “with the focus on Nigeria.’’ Methodology: The study Utilized annual time-series data on exogenous variables (Government Deficit Spending, GDS; Official exchange rate, OEXCHR; Monetary policy rate, MPR) to capture Macroeconomic fundamentals. While, Unemployment rate, UNEMPLR; Inflation rate, INFLR and Consumer price index, CPI were used as a summation of Macroeconomic phenomena to capture Misery index. The data on variables used in the study were sourced from Nigerian federal ministry of finance; Central Bank of Nigeria; and World Bank data bank between 1991and 2022 respectively. The study employed econometric techniques of ordinary least square and Two-stage least to analyze its data. Findings: The study of Ordinary Least Square revealed that Government deficit spending and official exchange rate significantly eradicate misery index in a positive manner. Meanwhile, monetary policy rate insignificantly eradicate misery index in a negative manner. There was also a further revelation from the findings of two-stage least square that government deficit spending and official exchange rate exert concerted significant strength to eradicate misery from every citizen of Nigeria within the periods under study.. Meanwhile, the result found that it was insignificantly weak for monetary policy rate (MPR) to minimize misery index from every Nigerian citizen within the periods under study. Unique Contribution to Theory, Practice and Policy: The study concluded that the authority should maintain a sound policy that will oversee money borrowed for critical projects and use it to create employment opportunity for Nigerian citizenry, ensure exchange rate is kept within a certain band that will reduce high cost of goods and services in the economy that we are currently facing and jettison the idea of increasing monetary policy rate, since this displayed a negative sign to help reducing misery index of the Nigerian populace during the periods of study.

Clinical and economic benefits of patients undergoing lobectomy with the use of powered vascular staplers—based on China’s real-world data

Background Endoscopic surgery is widely performed with an increasing use of powered vascular staplers (PVS). However, few studies have examined PVS use in China, most of which have focused on clinical effects; fewer studies have examined the economic benefits of PVS. This study evaluated the clinical and economic benefits of the PVS compared to standard-of-care (SOC) staplers in lobectomy using results from a single-arm, multicenter clinical trial conducted in China and actual clinical use in a hospital collected in a real healthcare setting. Methods Patients with lung cancer undergoing thoracoscopic lobectomy were included in the study. The clinical and economic benefits of powered vascular stapler have been evaluated from a hospital’s perspective based on parameters such as bleeding occurrence, hospitalization time, secondary thoracotomy, and hospitalization costs. To compare the bleeding associated with use of PVS and SOC stapler in clinical use, PVS single-arm multi-center clinical trial data is used for the intervention group, and sampling data from hospitals is used for the control group. To ensure the outcome indicators between the two groups are comparable, we set the same inclusion criteria for the two groups of data and then used propensity score matching (PSM) to match two groups of patients according to the baseline characteristics. Results The results show that bleeding incidence in patients with SOC stapler group is 17.33% from hospital sampling data. In contrast, in the PVS group, it is 4.00%, and these rates are statistically different (P = 0.0167). Considering converted to open thoracic surgery, the rate of the SOC stapler group is 5.78% and that of the PVS group is 4.00%. These rates are not statistically different (P = 0.6166). Regarding hospitalization days, the length of the SOC stapler group is 18.97 days, while that in the PVS group is 12.38 days, and these data are statistically different (P = 0.0002). As patients in the PVS group have reduced bleeding, they will require less resource use from blood transfusion, drug services and surgical services. If PVS is used for transection of vessel, it can reduce the bleeding incidence by 13.33% and save 75.47 CNY in blood transfusion costs, 571.36 CNY in drug costs, and 183.38 CNY in surgical service costs per patient. From these three aspects, the hospital saves per patient 830.21 CNY. Conclusions Compared with the SOC stapler group, the PVS group has a lower bleeding incidence and shorter hospital days for lobectomy. In terms of blood transfusion costs, drug costs and surgical service costs, the hospital saves per patient 830.21 CNY.

Spatial Patterns of Emergency Dental Care Utilization: Assessing the Influence of Social Vulnerability and Dental Provider Availability

Aim: Our aim was to examine the association between emergency dental care use and dental providers’ availability and ZIP code social vulnerability index. Methods: This cross-sectional observational study mapped variations in emergency dental care and analyzed their association with social vulnerability using generalized spatial two-stage least-squares to address spatial correlation. To perform spatial autoregressive modeling to examine how dental provider capacity and social vulnerability influence emergency care use across neighboring counties, accounting for ZIP Code Tabulation Area (ZCTA) spillover effects, we used secondary data from the Maryland Health Services Cost Review Commission, InfoUSA, and the US Census American Community Survey. We focused on emergency dental care usage in ZIP Code Tabulation Areas, using emergency department visits and inpatient stays per 1000 residents for dental conditions, as the dependent variable. Results: Highly vulnerable ZCTAs saw 5.9× more non-traumatic dental condition (NTDC) ED visits, 5.3× more chronic dental ED visits, 3.3× more NTDC inpatient stays, and 1.3× more chronic dental inpatient stays than less vulnerable areas. For all four measures of emergency dental care use, increased dental provider availability was associated with reductions in use of emergency dental care (ED), while higher social vulnerability was associated with increased use. For example, an increase of one dental provider per 1000 residents was associated with a reduction of 28.2 non-traumatic dental ED visits, while a high social vulnerability index was associated with an increase of 88.6 non-traumatic dental ED visits. Conclusions: There was an association among dental provider availability, social vulnerability, and the use of emergency dental care.

МАРКЕТИНГОВІ ДОСЛІДЖЕННЯ ВПЛИВУ ЦІНОВОЇ ПОЛІТИКИ НА ПОВЕДІНКУ СПОЖИВАЧІВ

Abstract Introduction. Economic terms "marketing pricing policy" are considered in the article, "behavior of consumers", interpretation different foreign and home scientists, it is given their description. The role of marketing pricing policy is investigational for companies and consumers of products or services. It is considered types of consumer behavior and their reaction on a price. The purpose of the article. Research of approaches in relation to determination of concept "marketing pricing policy" their value and terms of pricing, consideration of term "behavior of consumers", research of types of behavior of consumers and their reaction on a price. Methods. During research the methods of comparison, analysis, synthesis, abstraction, theoretical, historical and logical generalization are used. The dialectical method of research became methodological basis. Results. It is exposed essence of economic term "marketing pricing policy" and "behavior of consumers". The conducted research showed that a competent price policy is an important component of the company's marketing strategy, because the price is one of the key factors taken into account by consumers when making purchase decisions. The study of consumer behavior is a priority area in the activity of any company, because consumers, after purchasing goods, bring profit to it. Therefore, for the successful operation of the company, customers must be in the center of attention. By studying consumers, their motives, wishes, price categories, and purchase processes, companies try to offer buyers exactly what they need. Conclusiоns. A study of theoretical and practical aspects of the marketing policy of pricing and consumer behavior was conducted, the types of consumer behavior and their reaction to the price were investigated. It was determined that the influence of marketing price policy on consumers is a key factor in making a purchase decision. Price politics determines the cost of commodities and services, that influences on perception of general utility of product consumers. The question of the factors that influence the behavior of consumers that most encourage the purchase of goods or services requires further research. Defining the role and place of price in making a purchase.

Health Care Utilization Among Medicare Beneficiaries With Newly Diagnosed Back Pain

BackgroundLow back pain (LBP) is the most common medical cause of disability among adults 65 or older. No previous study has characterized health care costs and treatment patterns of LBP among Medicare beneficiaries. MethodsThis retrospective cohort study quantifies health care utilization costs among Medicare beneficiaries with newly diagnosed LBP, compares costs between patients managed operatively and nonoperatively, identifies costs associated with treatment guideline nonadherence, and characterizes opioid prescribing patterns. Patients were queried via ICD codes from a 20% random sample of Medicare claims records. Patients with concomitant or previous “red flag” diagnoses, neurological deficits, or diagnoses that could cause non-degenerative LBP were excluded. Total costs of care in the year of diagnosis were calculated and stratified by operative versus nonoperative management. To assess for guideline adherence, utilization and costs of different services were tabulated. Opioid prescription patterns were characterized by quantity, cost, duration, and medication type. Results1,269,896 patients were identified; 23,919 (1.8%) underwent surgery. These accounted for 7% of the cohort's total cost ($514 million total, $21,496 per person). Patients treated nonoperatively accounted for over $7 billion in costs ($5,880 per person; p<0.001). Within the nonoperative cohort, 626,896 (50.3%) patients were nonadherent to current guidelines for conservative management of LBP. Guideline nonadherence increased total annual costs by $4,012 per person ($7,873 for nonadherent vs. $3,861 for adherent patients, p<0.001). 460,867 opioid prescriptions were filled for 303,796 unique patients (23.9%) within 30 days of LBP diagnosis. Within the nonsurgical cohort, patients nonadherent to imaging guidelines were more likely to have an opioid prescription within this window than adherent patients (26.5% vs. 21.2%; p<0.001). ConclusionsNonoperative management of LBP is associated with significantly lower costs per patient. Early imaging and opioid prescription are significant drivers of excess cost. Adherence to proposed treatment guidelines can save over $2.8 billion in total health care costs.

The Curious Persistence of Site-Dependent Payments

This Viewpoint considers supply- instead of buy-side pressure to address the inflated cost of basic health services provided by hospitals.

Optimal Strategies for E-Commerce Platform Supply Chain: Carbon Emission Reduction and Financing

In the context of global carbon emission reduction (CER) targets and slowing economic growth, it is imperative for suppliers to make informed choices regarding CER and financing strategies. However, limited research has explored the impact of financing strategies on CER. This paper develops a supply chain model that includes a supplier, a manufacturer, an E-commerce platform (E-C platform), and consumers with a preference for low-carbon products. The supplier sets the wholesale price, while the manufacturer controls both the production quantity and the unit amount of CER. We examine whether the manufacturer will invest in CER with sufficient capital or under various financing scenarios, namely (1) traditional production with sufficient capital (Scenario ST); (2) CER implementation with sufficient capital (Scenario SG); (3) CER implementation with E-C platform financing (Scenario EG); (4) CER implementation with bank financing (Scenario BG). Through comparative analysis, the analysis reveals that, regardless of the financing method chosen, the supplier’s profit and the manufacturer’s production quantity increase when the manufacturer invests in CER technology innovation compared to the traditional scenario. Furthermore, in terms of the manufacturer’s profit, if the service cost of bank financing exceeds a certain threshold, the manufacturer should either seek financing from the E-C platform or abandon the CER investment. Additionally, with respect to CER outcomes, Scenario BG outperforms Scenario EG. These findings provide a theoretical foundation and decision-making support for supply chain participants when addressing carbon reduction and financing strategy decisions.

Hierarchical Game Theory-Based Optimal Power Management for Both Seaports and Ships

Unlike land-based power systems, a seaport microgrid is not only equipped with extensive electrification but also connected with ships, which turns maritime power management into a comprehensive transportation-power coordination problem. To fully exploit the potential of shipboard power systems for energy efficiency improvement of seaports, a hierarchical Stackelberg game-based framework is developed in this paper to achieve efficient power management for both seaports and ships. In this framework, the seaport microgrid serves as a leader to manage the local sources and determine the price for ships to maximize revenue, considering the influence of both the power side and transportation side. On the other hand, the ships act as followers to decide the charging and service strategies for an optimal trade-off between the benefits from onboard battery charging and the ship service cost. The proposed game is solved as a bilevel optimization problem via mathematical programming with the equilibrium constraints method. The proposed algorithm's efficiency is evaluated through numerical simulations. The simulation results demonstrate that the proposed power management method can simultaneously increase the economic profits of seaports and improve the service of ships at berth. Compared to traditional energy management methods, the comprehensive benefits can be increased by approximately 36%.

Reconsidering the City of New York Directive on Mental Health Involuntary Removals

Abstract Background Homelessness is a visible manifestation of large-scale societal challenges, such as lack of affordable housing, poverty, and health inequities. Governments may miss opportunities to address these structural problems by removing people experiencing homelessness from public spaces. On 29 November 2022, after a press conference by Mayor Eric Adams, the city of New York issued a directive entitled Mental Health Involuntary Removals. The program authorized mental health providers and NYPD officers to take any person into custody who appears mentally ill and displays inability to meet basic living needs, even when no dangerous act has been observed. Methods We reviewed the existing literature from 1973 to 2023 for studies, enacted legislation, state and federal policies, and interventions related to homelessness, mental health, and admission of people experiencing homelessness into psychiatric hospitals in the United States. We used academic databases, including PubMed, PsycInfo, and JSTOR for peer-reviewed articles, government reports, and policy analyses. Our search strategy included keyword combinations such as “homelessness and mental health,” “policy interventions for homeless populations,” and “health care services costs.” We applied inclusion criteria focusing on reports and articles that directly address the intersectionality of homelessness, mental health policy, and psychiatric care. Results Homelessness and mental illness frequently intersect, creating complex challenges that require nuanced solutions. Forced hospitalization of people experiencing homelessness in New York City, while intended to address critical social and health care issues, carries a risk for significant long-term harm. This approach places strain on the mental health care system and may ultimately exacerbate the problems it purports to resolve.

Cost-utility analysis of provision of e-cigarette starter kits for smoking cessation in emergency departments: An economic evaluation of a randomized controlled trial.

To assess the cost-effectiveness of the Cessation of Smoking Trial in Emergency Department (COSTED) intervention compared with signposting to local stop smoking service (SSS) from the National Health Service (NHS) and personal social services (PSS) perspective. This was a two-group, multi-centre, pragmatic, individually randomized controlled trial set in six Emergency Departments (EDs) in urban and rural areas in the United Kingdom. Adult (≥ 18 years) daily smokers (at least one cigarette or equivalent per day) but not daily e-cigarette users, with carbon monoxide reading ≥8parts per million, attending the ED (n= 972) were included. The intervention consisted of provision of an e-cigarette starter kit plus brief smoking cessation advice and referral to a local SSS. Control was an information card on how to access local SSS. Intervention costs included costs of training and delivery. Control costs included costs of printing information cards. Costs of smoking cessation and health-care services were estimated based on quantities reported by participants and unit costs extracted from secondary sources. The effects were measured by quality-adjusted life years (QALYs) derived from EQ-5D-5L. Other outcomes were smoking cessation measures. The primary outcome was incremental cost-effectiveness ratio (ICER), which was calculated by dividing the difference in costs by the difference in QALYs between groups. The mean intervention costs were £48 [standard error (SE) = £0] per participant and the mean control costs were £0.2 (SE = £0) per participant. Using regression estimates, total costs were £31 [95% confidence interval (CI) = -£341 to £283] higher and 6-month QALYs were 0.004 (95% CI = -0.004 to 0.014) higher in the intervention group than in the control group. The ICER was calculated at £7750 (probability of cost-effective at range £20 000-30 000: 72.2-76.5%). The UK Cessation of Smoking Trial in Emergency Department (COSTED) intervention (provision of an e-cigarette starter kit plus brief smoking cessation advice) was cost-effective compared with signposting to local stop smoking services under the current recommendations of the maximum acceptable thresholds.

A Simheuristic Approach to Scheduling Sustainable and Reliable Maintenance for Bridge Infrastructure

Designing maintenance strategies for a vast portfolio of aging infrastructures requires decision-makers to ensure adequate safety levels while addressing the requirements on service interruptions, costs, and workforce availability. This study addresses the problem of scheduling maintenance interventions for a portfolio of bridges, aiming to minimize CO2 emissions while meeting minimum reliability requirements and adhering to workforce and budget constraints. To achieve this, we present a Simheuristic algorithm that combines a metaheuristic core based on the Adaptive Large Neighborhood Search metaheuristic with a Monte Carlo simulation module. This integration allows for the evaluation of optimized scheduling solutions, accounting for the inherent randomness in the structural deterioration process. The proposed approach is tested in a comparative analysis against traditional time-based and condition-based scheduling methods. Results from diverse bridge portfolios demonstrate that the proposed algorithm offers improved performance in terms of both total costs and CO2 emissions.

User preferences for an mHealth app to support HIV testing and pre-exposure prophylaxis uptake among men who have sex with men in Malaysia.

Recent estimates report a high incidence and prevalence of HIV among men who have sex with men (MSM) in Malaysia. Mobile apps are a promising and cost-effective intervention modality to reach stigmatized and hard-to-reach populations to link them to HIV prevention services (e.g., HIV testing, pre-exposure prophylaxis, PrEP). This study assessed attitudes and preferences toward the format, content, and features of a mobile app designed to increase HIV testing and PrEP uptake among Malaysian MSM. We conducted six online focus groups between August and September 2021 with 20 MSM and 16 stakeholders (e.g., doctors, nurses, pharmacists, and NGO staff) to query. Transcripts were analyzed in Dedoose software to identify thematic content. Key themes in terms of app functions related to stylistic preferences (e.g., design, user interface), engagement strategies (e.g., reward systems, reminders), recommendations for new functions (e.g., enhanced communication options via chat, discussion forum), cost of services (e.g., PrEP), and legal considerations concerning certain features (e.g., telehealth, patient identification), minimizing privacy and confidentiality risks. Our data suggest that a tailored HIV prevention app would be acceptable among MSM in Malaysia. The findings further provide detailed recommendations for successfully developing a mobile app to improve access to HIV prevention services (e.g., HIV testing, PrEP) for optimal use among MSM in Malaysia.

Research on How the Digital Economy Contributes to Achieving A High-Level and Balanced Development of the Elderly Care Service Industry

Abstract China’s aging population has gained significant attention. Population aging implies that the demand for elderly care services will be on the rise. However, China’s aging exhibits a notable characteristic of getting old prior to achieving affluence, which directly constrains the enhancement of the level of elderly care services. The Communist Party of China and the government attach considerable importance to the issue of population aging and pensions. The Third Plenary Session of the 20th CPC Central Committee adopted the Decision of the CPC Central Committee on Further Comprehensively Deepening Reform and Promoting Chinese-Style Modernization, emphasizing that “we should actively respond to population aging and improve the development of elderly care and elderly care industry policy mechanisms.” Regarding the supply of pension services, due to the professional and long-term nature of pension services, the supply cost remains high. The contradiction between the low level of demand and the high cost of supply might lead to the “low-level equilibrium trap” of the elderly service industry. The digital economy has achieved remarkable effects in promoting the elderly care service industry. It has played a vital role in optimizing the allocation of elderly care resources, reducing the cost of elderly care services, and creating a superior elderly care ecosystem. In this context, it holds considerable academic value and practical significance to study the impact of the digital economy on the development of pension service industry, to analyze the digital divide and bridge the path for the development of the pension service industry, and to explore the countermeasures and ideas of the digital economy to facilitate the high-level, balanced, and high-quality development of the pension service industry.